This invention relates to a device for use hi visualization of the spine in vivo for diagnosis and treatment. More particularly, the invention concerns a flexible endoscope having a deflecting tip for changing the viewing angle of a removable fiber-optic bundle and for providing a means for steering the endoscope through tight spaces.
Low back pain syndrome represents a major health problem in the United States. In recent years, practitioners in the spinal field have sought methods to minimize the invasive nature of diagnosis and treatment of the causes of low back pain syndrome. Surgeons and other practitioners in the field have also sought ways to minimize the invasive nature of other more serious spinal surgery such as reducing vertebral fractures, implanting prosthetic vertebrae or implanting spinal fixation devices.
Typically, spinal diagnosis and treatment is conducted under indirect visualization techniques, such as magnetic resonance imaging (MRI), catscan (CT) and more frequently, fluoroscopic X-ray or radiographic monitoring using a C-arm image intensifier. Direct visualization of specific affected regions of the spine can be obtained through surgical incisions through the skin and fat layer. Less invasive percutaneous techniques, such as suggested by Jacobsen in U.S. Pat. No. 4,545,374 or by Kambin in U.S. Pat. No. 4,573,448, are thus far typically performed under indirect visualization. There remains a need therefore, for a means for direct visualization of the spinal column, including the vertebrae, disc tissue and the epidural and intra-discal spaces, without extensive surgery.
Visualization of the spine carries with it significant difficulties over visualization of other body regions, such as the knee. Direct visualization of the knee has been readily accomplished using rigid arthroscopes, since there is very little requirement for guiding or steering the fiber-optic bundle through this joint. On the other hand, the spinal column consists of several joints. Moreover, the configuration of the vertebrae themselves hamper the ability for direct visualization, at least using a rigid endoscope device. Oftentimes, it is necessary to view a vertebra from both posterior and anterior positions. No known rigid endoscope appears to be capable of permitting direct visualization in all regions of the spinal column.
Consequently, there is a significant need in the field of spinal diagnosis and treatment for a device that permits direct visualization of the spine in vivo from virtually any position. The device must be flexible so that it can be guided to the different positions along the spine. It must also have the capability of changing the orientation of the viewing angle field as required to fully visualize the suspect region of the spine.